<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Doctor_ids')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-doctor_ids" data-rule="required" data-source="docdepartment/doctor/index" data-field="doctor_name" data-multiple="true" class="form-control selectpage" name="row[doctor_ids]" type="text" value="{$row.doctor_ids|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Clinc_score_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-clinc_score_id" data-rule="required" min="0" data-source="shopro/store/store/store_list" class="form-control selectpage" name="row[clinc_score_id]" type="text" value="{$row.clinc_score_id|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Clinc_theme')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-clinc_theme" data-rule="required" class="form-control" name="row[clinc_theme]" type="text" value="{$row.clinc_theme|htmlentities}">
        </div>
    </div>

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Price')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-price" data-rule="required" class="form-control" name="row[price]" type="text" value="{$row.price|htmlentities}">
        </div>
    </div>

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Inquiry_time')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-inquiry_time" data-rule="required" min="0" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[inquiry_time]" type="text" value="{:$row.inquiry_time?datetime($row.inquiry_time):''}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Inquiry_address')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-inquiry_address" data-rule="required" class="form-control" name="row[inquiry_address]" type="text" value="{$row.inquiry_address|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Ctime')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-ctime" data-rule="required" min="0" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[ctime]" type="text" value="{:$row.ctime?datetime($row.ctime):''}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Activity_start_time')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-activity_start_time" data-rule="required" min="0" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[activity_start_time]" type="text" value="{:$row.activity_start_time?datetime($row.activity_start_time):''}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Activity_end_time')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-activity_end_time" data-rule="required" min="0" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[activity_end_time]" type="text" value="{:$row.activity_end_time?datetime($row.activity_end_time):''}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Status')}:</label>
        <div class="col-xs-12 col-sm-8">
            
            <div class="radio">
            {foreach name="statusList" item="vo"}
            <label for="row[status]-{$key}"><input id="row[status]-{$key}" name="row[status]" type="radio" value="{$key}" {in name="key" value="$row.status"}checked{/in} /> {$vo}</label> 
            {/foreach}
            </div>

        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-success btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
